Angina with "normal" coronary arteries: a changing philosophy

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Many women with angina receive a diagnosis of no significant heart disease despite normal coronary arteries.
• Reassurance is often the only treatment offered, potentially delaying necessary interventions.

Purpose of the Study:

• To review the diagnosis and therapy for angina in patients with normal or nonobstructive coronary arteries.
• To highlight the underappreciated prognosis and treatment strategies for this patient group.

Main Methods:

• Systematic literature search of MEDLINE and Cochrane Database of Systematic Reviews up to June 2004.
• Inclusion of reference lists and meeting presentations for comprehensive data.
• Keywords focused on angina diagnosis and therapy with normal angiography.

Main Results:

• Normal or nonobstructive coronary disease is common, especially in women with myocardial infarction.
• Patients with nonobstructive disease are more likely women and nonwhite, with symptoms indistinguishable from obstructive disease.
• A significant portion of women with normal angiography exhibit myocardial ischemia due to endothelial dysfunction, indicating increased future cardiac event risk.

Conclusions:

• Chest pain with normal angiograms predominantly affects women and carries a more serious prognosis than often assumed.
• Endothelial function assessment can identify patients at risk for future cardiac events.
• Therapies should include symptom relief (tricyclic agents, beta-blockers) and aggressive antiatherosclerotic treatment (statins, ACE inhibitors) based on risk factors.